Ultrasound measurement of the uterocervical angle before embryo transfer: a prospective controlled study.

BACKGROUND: The study aim was to determine whether moulding the embryo transfer catheter according to the uterocervical angle measured by ultrasound could improve pregnancy and implantation rates. METHODS: Patients were alternately allocated to one of two groups. In the ultrasound-guided group (n = 320), the catheter was moulded according to the uterocervical angle measured by abdominal ultrasound. In controls (n = 320), embryo transfer was performed using the "clinical feel" method. RESULTS: Moulding the embryo transfer catheter according to the uterocervical angle significantly increased clinical pregnancy [(OR = 1.57, 95% CI (1.08-2.27)] and implantation rates [(OR = 1.47, 95% CI (1.10-1.96)] compared with the "clinical feel" method. It also significantly reduced difficult transfers [(OR = 0.25, 95% CI (0.16-0.40)] and blood during transfers [OR = 0.71, 95% CI (0.50-0.99)]. Patients with large angles (>60 degrees ) had significantly lower pregnancy rates compared with those with no angle [OR = 0.36, 95% CI (0.16-0.52)]. CONCLUSIONS: Moulding the embryo transfer catheter according to the uterocervical angle measured by ultrasound increases clinical pregnancy and implantation rates and diminishes the incidence of difficult and bloody transfers.

Minimal requirements for a successful outcome in anovulatory patients treated with human menopausal gonadotropins.

OBJECTIVE: To determine the minimal requirements for achieving a full-term singleton pregnancy in hMG-treated patients. METHODS: One hundred and ninety-two pregnancy cycles resulting from hMG therapy in infertile patients were retrospectively studied to determine the minimal requirements for the occurrence of a pregnancy in those women. The cycles were divided into five groups: pregnancies ending in miscarriage, ectopic pregnancies, pregnancies ending in preterm delivery, full-term singleton pregnancies, and full-term multiple pregnancies. The number of hMG ampules, the number of preovulatory follicles reaching 18 mm or more in diameter, the cervical mucus score (Insler), the number of living spermatozoa per high-power field (HPF) observed in the cervical mucus on the day of hCG administration, and the midluteal plasma progesterone concentration were determined and correlated with the outcome of the pregnancy in the five groups studied. The minimal requirements for the occurrence of a full-term singleton pregnancy were also determined. RESULTS: In this cohort of 192 women, the mean number of hMG ampules administered was 25.38 (1903.5 IU), the mean number of preovulatory follicles reaching 18 mm was 2.1, the mean cervical mucus score (Insler) was 9.48, and the mean number of motile spermatozoa per HPF in the cervical mucus on the day of hCG administration was 19.3. There were no statistically significant differences between the five groups studied regarding these four variables. The mean midluteal plasma progesterone concentration was 29.07 ng/mL and there was no statistically significant difference in midluteal plasma progesterone concentration between the cycles resulting in full-term deliveries and those ending in miscarriage. However, a statistically significant difference in midluteal plasma progesterone concentration was found between the cycles resulting in full-term singleton pregnancies and those resulting in full-term multiple pregnancies. CONCLUSIONS: The minimal requirements for achieving a full-term singleton pregnancy were 9 ampules of hMG (675 IU), one 18-mm follicle, a cervical mucus score (Insler) of 6 on the day of hCG administration, and a midluteal plasma progesterone concentration of 10.83 ng/mL. The presence of motile spermatozoa in the cervical mucus was a reassuring sign in 92.7% of instances but was not an absolute necessity for a successful outcome.